Provider Demographics
NPI:1669744942
Name:ROTZ, ROLAND (PHD)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:ROTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2015
Mailing Address - Country:US
Mailing Address - Phone:805-566-0441
Mailing Address - Fax:805-566-0051
Practice Address - Street 1:957 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-2015
Practice Address - Country:US
Practice Address - Phone:805-566-0441
Practice Address - Fax:805-566-0051
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical